Provider Demographics
NPI:1477916427
Name:CHAALAN, TINA
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:CHAALAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25080 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-1740
Mailing Address - Country:US
Mailing Address - Phone:313-730-8880
Mailing Address - Fax:313-730-1167
Practice Address - Street 1:25080 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-1740
Practice Address - Country:US
Practice Address - Phone:313-730-8880
Practice Address - Fax:313-730-1167
Is Sole Proprietor?:No
Enumeration Date:2016-03-29
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301502528207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology